Surgical anatomy of supraumbilical port placement Implications for robotic and advanced laparoscopic surgery

Original Video Article

Capsule:
This video describes the surgical anatomy of the supraumbilical region and the distances of the port sites at 1-cm increments from the umbilicus in relation to the great vessels.

Authors:
Mohamed A. Bedaiwy, M.D., Ph.D., Areiyu Zhang, M.D., Drisana Henry, B.A., Tommaso Falcone, M.D., Enrique Soto, M.D.

Volume 103, Issue 4, Page e33

Abstract:

Objective:
To describe the surgical anatomy of the supraumbilical region and to provide guidelines for insertion technique.

Design:
Educational video.

Setting:
Tertiary university hospital.

Patient(s):
A study population of 92 women.

Intervention(s):
Abdominal thickness was measured from the skin to the anterior peritoneum. Distance to the aorta and the IVC was measured from the anterior peritoneum to the most superficial border of the vessel. Mean values are presented for the distances from the umbilicus to the aorta and the IVC and at 1-cm increments cephalad to the umbilicus. Pearson correlation coefficients and 95% confidence intervals were calculated to describe the association between BMI and the distance and thickness measurements.

Main Outcome Measure(s):
Abdominal wall thickness, distance to the aorta and inferior vena cava.

Result(s):
Abdominal wall thickness increases the more cephalad above the umbilicus. The distance to the great vessels decreases at 1-cm increments above the umbilicus until 2 cm. The greatest distance from the entry point to the aorta and the IVC is at 5 cm above the umbilicus. However, the abdominal wall is also the thickest at this point, particularly in obese patients. Thus, the overall distance from the skin to the great vessels is reduced as BMI increases. The distal end of the falciform ligament, which is a fold of the peritoneal ligament, is on average 6.5 cm from the umbilicus.

Conclusion(s):
It is prudent for the surgeon to be cognizant of distance variations and risk of vessel injury with obese patients. If the supraumbilical entry is necessary, it is recommended to do so at 5 cm cephalad to the umbilicus. These anatomical relationships should be considered to avoid injury to the aorta and the IVC as well as intraligamentary preperitoneal insufflation.

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